This is a case report of pernicious anemia with neurologic deficits. The patient is a 69 years old male with generalized tingling sense. On examination, slight pale conjunctiva and beefy red tongue are noted. Laboratory stud show megaloblastic anemia with low serum vitamin B12 level, positive Schilling test, gastric achlorhydria and mild gastric atrophy. Neurologic examination reveals cerebral, spinal and peripheral involovement and EEG and EMG study support those things. On parenteral vitamin B12, the hematologic and neurological abnormalities are improved dramatically.
Achlorhydria ; Aged ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Atrophy ; Conjunctiva ; Electroencephalography ; Humans ; Male ; Neurologic Examination ; Neurologic Manifestations ; Schilling Test ; Tongue ; Vitamin B 12

We present a case of pernicious anemia without history of operation in 52 year old female. She suffered from oral ulcer, gum bleeding, nausea, vomiting, and beefy tongue. She had dysesthesia on the both arm and foot, and hypesthesia of global and stocking type by neurologic examination. Laboratory findings were as follows: serum cobalamin 9.1 pg/mL (normal range: 180-710pg/mL), anti intrinsic factor antibody (strong positive), antiparietal cell Antibody 1:10 (positive), first stage of Schilling test (1.4%). The findings of peripheral blood and bone marrow were compatible with megaloblastic anemia. We report a case of pemicious anemia with positive anti intrinsic factor antibody and antiparietal cell antibody.
Anemia ; Anemia, Megaloblastic ; Anemia, Pernicious* ; Arm ; Bone Marrow ; Female ; Foot ; Gingiva ; Hemorrhage ; Humans ; Hypesthesia ; Intrinsic Factor* ; Middle Aged ; Nausea ; Neurologic Examination ; Oral Ulcer ; Paresthesia ; Schilling Test ; Tongue ; Vitamin B 12 ; Vomiting

Pernicious anemia is understood as an autoimmune disease and associated with various other autoimmune diseases, such as Graves` disease, primary hypothyroidism, thyroiditis and vitiligo. We report a case of pernicious anemia associated with autoimmune thyroiditis. A 40-year-old man was admitted to the Sanggye Paik Hospital due to general weakness, dyspnea on exertion and sore throat for 2 months. Eight years before admission, he had been treated with hyperthyroidism in other hospital. Examination revealed anemic conjunctivae, exophthalmos and smooth and beefy tongue. Laboratory tests showed 6.2g/dL of hemoglobin, 16.7% of hematocrit, 7,970/microliter of WBC, 152,000/microliter of platelets and 116.3fL of MCV. Reticulocyte index was 0.3%. Peripheral blood smear showed macrocytic red blood cells and hypersegmented neutrophils. The level of vitamin B12 was 139.2pg/mL and folic acid was in normal range. The result of schilling test was abnormal. Anti-parietal cell antibody was positive. The results of thyroid function tests were compatible with hypothyroidism and anti-microsomal antibody was positive. TBII was 9.8U/L. Treatment with vitamin B12 and thyroid hormone was started. Three months after treatment, he has been completely free of symptoms. Now he has been treated with thyroxine 0.2mg per day and adenosylcobalamine 1,000microgram per 2 month.
Adult ; Anemia, Pernicious* ; Autoimmune Diseases ; Conjunctiva ; Dyspnea ; Erythrocytes ; Exophthalmos ; Folic Acid ; Hematocrit ; Humans ; Hyperthyroidism ; Hypothyroidism ; Neutrophils ; Pharyngitis ; Reference Values ; Reticulocytes ; Schilling Test ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Autoimmune ; Thyroxine ; Tongue ; Vitamin B 12 ; Vitiligo